Buddeke Josefien, Gernaat Sofie A M, Bots Michiel L, van den Bongard Desirée H J G, Grobbee Diederick E, Vaartjes Ilonca, Verkooijen Helena M
Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands.
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
BMJ Open. 2019 May 30;9(5):e022664. doi: 10.1136/bmjopen-2018-022664.
To investigate trends in cardiovascular disease (CVD) risk following breast cancer using national registry data.
A nationwide cohort study was conducted, comprising 163 881 women with in situ (7.6%) or invasive (92.4%) breast cancer and women of the general population, ranging from 3 661 141 in 1996 to 4 566 573 in 2010. CVD mortality rate in women with and without breast cancer and hospitalisation rate after breast cancer were calculated for the years 1996-2010. Age-adjusted CVD and breast cancer mortality within 5 years after breast cancer admission (1997-2010) were compared with 1996 calculated with a Cox proportional hazard analysis.
The absolute 10-year CVD mortality risk following breast cancer decreased from 56 per 1000 women in 1996 to 41 in 2005 (relative reduction=27.8%). In the general population, this decreased from 73 per 1000 women in 1996 to 55 in 2005 (-23.9%). The absolute risk of CVD hospitalisation within 1 year following breast cancer increased from 54 per 1000 women in 1996 to 67 in 2009 (+23.6%), which was largely explained by an increase in hospitalisation for hypertension, pulmonary embolism, rheumatoid heart/valve disease and heart failure. The 5-year CVD mortality risk was 42% lower (HR 0.58, 95% CI=0.48 to 0.70) for women admitted for breast cancer in 2010 compared with 1996.
CVD mortality risk decreased in women with breast cancer and in women of the general population, with women with breast cancer having a lower risk of CVD mortality. By contrast, there was an increase in hospitalisation for CVD in women with breast cancer.
利用国家登记数据调查乳腺癌患者心血管疾病（CVD）风险的变化趋势。
开展一项全国性队列研究，纳入163881例原位（7.6%）或浸润性（92.4%）乳腺癌女性患者以及普通人群女性，数量从1996年的3661141例到2010年的4566573例。计算1996 - 2010年乳腺癌患者和非乳腺癌患者的CVD死亡率以及乳腺癌后的住院率。采用Cox比例风险分析，将1997 - 2010年乳腺癌入院后5年内年龄调整后的CVD和乳腺癌死亡率与1996年的数据进行比较。
乳腺癌后10年CVD绝对死亡风险从1996年的每1000名女性56例降至2005年的41例（相对降低27.8%）。在普通人群中，这一数字从199年的每1000名女性73例降至2005年的55例（-23.9%）。乳腺癌后1年内CVD住院绝对风险从1996年的每1000名女性54例增至2009年的67例（+23.6%），这在很大程度上是由于高血压、肺栓塞、类风湿性心脏/瓣膜病和心力衰竭住院人数增加所致。与1996年相比，2010年因乳腺癌入院的女性5年CVD死亡风险降低了42%（HR 0.58，95% CI = 0.48至0.70）。
乳腺癌女性患者和普通人群女性的CVD死亡风险均降低，乳腺癌女性患者的CVD死亡风险更低。相比之下，乳腺癌女性患者的CVD住院人数有所增加。
